Mental Health

What's It All About, Alfie?

Anxiety

Despite being a more common condition than depression, anxiety is less diagnosed and often sufferers of severe anxiety fall under the radar for years or decades. This condition can be debilitating to any and all aspects of daily living, and though highly treatable, often remains chronically undermanaged. It is very common in gamers, though very little clinical research has been done to explain why. Our best guess is that individuals who have experienced or are vulnerable to anxiety are able to engage with games as an effective form of escapism, and may seek therapeutic benefits from the act of play.

Anxiety can occur at any stage in our life, even if it has never happened before. Anxiety presents itself in many ways, and its manifestations can be subtle enough to go unnoticed.

What is the difference between anxiety and fear?

They are very similar emotions. Generically, fear is described as a response to an immediate or imminent perceived threat, whereas anxiety is the response to the possibility of a threat. However, for sufferers of anxiety, threats which others would perceive as minor, or unlikely, can feel very real, and their body therefore responds in an appropriate way to this.

When is anxiety a disorder?

Everyone experiences anxiety. Anxiety as an emotion is an evolutionary mechanism which has successfully kept us safe from predators and environmental threats for millions of years. In modern society, however, it serves less of an important role in survival.

Anxiety becomes a disorder when it is intrusive (unwanted and unneeded), pervasive (continues despite attempts to deal with the threat) and/or leads to avoidance (not attending school/work/social activities etc to avoid experiencing anxiety).

What does anxiety feel like?

Anxiety can manifest in so many ways. I have categorised them for ease of reading, but any symptom from any category can occur together in any combination.

Thought-based symptoms

Rumination (going over and over the same scenerio or problem in your head)

Scrambled or disorgised thoughts

Excessive worrying that is very difficult or impossible to reassure

Desire to repeat certain behaviours and excessive "checking"

Irritability and avoidant behaviour

Worry and paranoia about what others think of us

Self-doubt and derogatory thoughts

A feeling that something bad is going to happen

Difficulty trusting others

Physical Symptoms (anxiety based)

Palpitations (awareness of the heart beat)

Sweating

Shortness of breath

A tight feeling in the chest or abdomen

Tingling hands/feet/limbs/lips

Dizziness

Feeling faint

Nausea or vomiting

Psychosomatic Symptoms
The line between these and the category above is very blurred and there is no definite arbitary value to differentiate them. However by my understanding, someone who experiences psychosomatic symptoms may not necessarily attribute them to anxiety, and they often feel like there is a genuine medical cause (which exacerbates their anxiety further). The symptoms are very, very real, but there is no physically pathology or danger. They may not even feel anxious at all, and this response represents their body's way of coping.

Abdominal pain, bloating, nausea, diarrhoea, constipation, vomiting

Pelvic pain, severe period pains, amenorrhoea (no periods)

Chest pain, chest tightness, palpitations

Shortness of breath and hyperventilation

Headaches, dizziness, vertigo and feeling like you are going to faint

Generalised weakness and fatigue, muscle aches and pains

Please note - anxiety is a diagnosis of exclusion for these symptoms and this should be decided by a doctor. If you experience any of the above, consult with your doctor.

What are the different types of anxiety disorder?

Generalised Anxiety Disorder (GAD)

This can be described as an increased susceptibility to suffer anxious emotions, which occurs on most days. This can affect many aspects of every day life, including school, work, study, planning, relationships, timekeeping, hobbies, friendships, creativity, motivation or none of these. It can be so debilitating that they are all affected.

Social phobia

Anxiety arises when thinking of, or being in, social situations with other people. This can be IRL or online/digitally. Common worries are that others will either think or say things that are critical, embarrassing or humiliating. humiliating. There may also be worries about saying "the wrong thing", or not being able to think of anything, leading to personal or professional failure and even further consequences. The fear of these consequences may be completely out of proportion with the actual circumstances, but they feel very real and can be paralysing.

Specific phobias

Most people have a phobia. This means a fear of an object, event, or concept and it doesn't necessarily have to be completely irrational. This is an evolutionary mechanism which protects us. Most phobias come from a parent with the same phobia, or an early event. However, phobias can be more detrimental than they are helpful in modern society. For example, a severe phobia of heights may prevent a person from flying, and therefore doing their job, or agoraphobia (fear of open spaces/lots of people) may prevent someone from ever leaving the house.

Obsessive compulsive disorder (OCD)

OCD is characterised by long termintrusive thoughts and fears that cause extreme anxiety, leading to the sufferer feeling they need to perform certain behaviours or rituals to alleviate their anxiety. This may give temporary relief but the thoughts always return, leading to repetition of the behaviour. Common themes are of security (excessively checking doors are locked etc) and hygeine or contamination.

Post-traumatic stress disorder (PTSD)

Any traumatic event can cause a stress response, but PTSD is specifically exposure to real or threatened death, injury, or sexual violence. Other stressors such as losing a job or a divorce can cause similar condition called adjustment disorder (also known as situational depression). PTSD sufferers describe a wide variety of symptoms. For PSTD they have to relive the event (flashbacks, nightmares and intrusive thoughts are common) and display avoidant or dissociative behaviour - this means either avoiding events or conversations that remind them of the trauma, or not psychologically processing the event (or both).

Panic disorder

Panic attacks have all sorts of symptoms, and are associated with feelingsof anxiety. People report chest pain, shortness of breath, hyperventilation, dizziness, tingling, feeling something terrible is going to happen. They can often be mistaken for serious medical conditions. A panic disorder is when a person suffers recurrent panic attacks. Sometimes they are triggered by an event or stressor, and sometimes they happen spontaneously without any warning.

How do you treat anxiety?

It depends on what kind of anxiety it is and how severe. In some cases, self-help techniques are enough (see the resources section). More commonly, therapy is needed. Common, clinically approved approaches are CBT, counselling, and psychotherapy. Also hypnotherapy may be used. Medication is very effective for treating anxiety. A type of anti-depressant called an SSRI is the most common. This drug rewires the neuronal pathways of the brain in a long term way. You do not need to be depressed for this to work. The drugs usually take a month to start working and nine months to provide a long term effect. It is important for people to expect that they might not feel any different for a while and that treatment is a gradual and subtle process, otherwise they may become disillusioned with the therapy and give up.

Do you think this sounds like you? Visit your GP. Mental health is one of the most common reasons people go to their doctor. They are very experienced at assessing and making recommendations. If it is your first time discussing your mental health, they may recommend blood tests to make sure there isn't a physical cause for your symptoms, for example, thyroid problems. They may want you to return after trying self-help techniques before referring to a psychologist or starting medication. This is completely normal and your doctor is not trying to dismiss your problems.

If you are unhappy with the way that your doctor is managing your mental health, you are completely in your rights to find a new GP, eithr at your own practise or by finding a new one. This happens all the time and your doctor will not be offended. Doctors are human beings with personalities and sometimes you just don't click or understand each other.

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An initiative to provide an interface between the worlds of video games and psychology. A safe space for gamers to explore mental health issues. An educational resource tailored to gamers and a place to go when you are feeling lost or alone. Help yourself, help others, and help us to teach the world that there is nothing to be ashamed or afraid of when it comes to mental health.

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